NPIMap

Organization Active NPI

Anthony L. Jordan Health Corporation

Doing business as Jordan at CCIA

  • Federally Qualified Health Center (FQHC)
  • Canandaigua, NY
National Provider Identifier
1649529678
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ANTHONY L. JORDAN HEALTH CORPORATION
Doing business as
Jordan at CCIA
Practice address
120 N Main St
Suite 11
Canandaigua, NY 14424-1258
Phone
(585) 396-6980
NPI assigned
Sep 6, 2012
Last updated
Sep 7, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
ANTHONY L. JORDAN HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bridgette Wiefling, MD
Title
President/Ceo
Phone
(585) 423-2878

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

120 N Main St
Suite 11
Canandaigua, NY 14424-1258

Mailing address

82 Holland Street
Rochester, NY 14605-2131

Other names 1

  • Jordan at CCIA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040519001335 NY Part B Supplier - Clinic/Group Practice 8729079785 Receives reassigned benefits from 49 practitioners
10 other NPIs on this enrollment
Practice locations: Rochester, NY; Canandaigua, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649529678. Details of each certification follow.

  • CCN 331078 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 331078

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
JORDAN AT CCIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 12, 2013
Last certification
Sep 12, 2013
Ownership / control type
For profit – corporation
Facility address
120 North Main Street
Canandaigua, NY 14424

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Anthony L Jordan HLTH C

Locations

120 N Main St
Ste 11
Canandaigua, NY 14424
Phone (585) 396-0222

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Anthony L. Jordan Health CorporationRochester, NY, CCN 331027 Federally qualified health center Operational/Managerial Control Nov 1, 2010
Woodward CenterRochester, NY, CCN 331044 Federally qualified health center Operational/Managerial Control Aug 27, 2011

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 49

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346976000000",
    "number": "1649529678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 HOLLAND STREET",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146052131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N MAIN ST",
            "address_2": "SUITE 11",
            "city": "CANANDAIGUA",
            "state": "NY",
            "postal_code": "144241258",
            "telephone_number": "585-396-6980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY L. JORDAN HEALTH CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANTHONY L. JORDAN HEALTH CORPORATION",
        "enumeration_date": "2012-09-06",
        "last_updated": "2012-09-07",
        "status": "A",
        "authorized_official_last_name": "WIEFLING",
        "authorized_official_first_name": "BRIDGETTE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "585-423-2878",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jordan at CCIA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canandaigua, NY

Sources for this page

Verify at the official NPI Registry.